Celiac Disease May Disrupt Fertility

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This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Note that this study suggests that women with biopsy-proven celiac disease had significant fertility and pregnancy complications and smaller family size than those without the disease.

LAS VEGAS -- Women with celiac disease had significantly more problems related to fertility and pregnancy than a control group of women who did not have the condition, investigators reported here.

Patients with celiac disease had increased difficulty conceiving compared with controls (41.2% versus 36.5%, P=0.03), as well as more consultations with fertility specialists and higher rates of spontaneous abortion, preterm delivery, and cesarean section.

Women with celiac disease also tended to have a shorter duration of fertility, marked by later onset of menarche and younger age at menopause, Stephanie M. Moleski, MD, said at the American College of Gastroenterology meeting.

"On the basis of this retrospective analysis, we have concluded that there is a relationship between celiac disease, fertility, and pregnancy outcomes, suggesting a need for increased awareness of this association among patients and physicians," said Moleski, of Thomas Jefferson University Hospitals in Philadelphia.

Studies dating back more than 40 years have shown higher rates of menstrual abnormalities and pregnancy complications among women with celiac disease. However, inconsistency in the findings has led to continued investigation to determine the relationship between celiac disease and problems related to fertility and pregnancy.

Moleski and colleagues recruited patients treated for celiac disease at Jefferson, as well as members of the National Foundation for Celiac Awareness and the Gluten Intolerance Group, to participate in an anonymous Internet-based survey about fertility and pregnancy. Women without celiac disease also completed the survey and served as a control group.

Of approximately 1,000 women who completed the survey, 473 had physician-diagnosed celiac disease, including 298 women who had the condition confirmed by small-bowel biopsy. The group with biopsy-proven disease provided the basis for comparison with 560 women without celiac disease.

The results showed significant differences between proportions of women with and without celiac disease reporting:

Consultation with fertility specialists -- 22.4% versus 19%, P=0.04

A history of spontaneous abortions -- 43.3% versus 36.6%, P=0.02

A history of preterm delivery -- 23.2% versus 14%, P=0.007

Cesarean delivery -- 26.4% versus 23.8%, P<0.001

Fewer children -- 1.5 versus 1.84, P=0.007

The group with celiac disease also reported a slightly older age at menarche (12.7 versus 12.4 years, P=0.01).

Among women reporting a history of spontaneous abortion, more than 80% of miscarriages occurred prior to diagnosis of celiac disease, said Moleski.

During the discussion that followed the presentation, Moleski was asked about obstetrician/gynecologists' awareness of the association between celiac disease and fertility issues and their acting on the information by referring patients to fertility specialists.

Previous studies had shown a lack of awareness among gynecologists about the potential adverse effects of celiac disease on fertility and pregnancy, she said. Similarly, studies have suggested that gastroenterologists are not as aware of the association as family physicians are.

"This is something that needs to be addressed," said Moleski.

Moleski and colleagues had no relevant disclosures.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania